Bleeding Frequency Under Anticoagulant Treatment in Pulmonary Hypertension

Pulmonary hypertension (PHT) patients often receive long term oral anticoagulants. If the indication is strong, in the secondary chronic thrombo-embolism pulmonary hypertension (CTE-PHT) prevention, the frequent prescription (50 to 90% of patients) contrasts with their low level of proof in the PHT. Last but not least, anticoagulants are known to be the principal cause of iatrogenic hospitalization (bleeding).

The only one study scaling the tolerance of anticoagulants for this population found major hemorrhagic levels discording with the clinical practice : really high for connectives associated to pulmonary arterial hypertension (PAHT), and lower in "simple" pulmonary embolism in CTE-PHT. These discoveries could belong to methodological failures of this study: a retrospective, monocentric one, without adjudication of events by an independent committee. Furthermore, there were no information about the existence of a validated indication for anticoagulant treatments.

Patients are all followed during one year, to determine the annual frequency of major bleedings (according to the International Society on Thrombosis and Haemostasis (ISTH) international definition). Each event notified is validated by an independent committee for clinical events.

• Oral anticoagulant treatment (Drug), also known as warfarin (Coumadine®), fluindione (Préviscan®), acenocoumarol (Sintrom®): The treatment is delivered according to the usual practice.

Primary outcomes

• Number of major bleeding (according to the International Society on Thrombosis and Haemostasis definition) [1 year]: Major bleedings (according to the International Society on Thrombosis and Haemostasis definition) will be notified during one year under oral anticoagulant treatment.

Secondary outcomes

• Number of clinically relevant bleedings [1 year]: Clinically relevant bleedings (major and non major ones) will be notified during one year under oral anticoagulant treatment.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Patient insured or entitled to a social security scheme;
* Patient with confirmed pulmonary hypertension;
* Pulmonary hypertension among the following etiological diagnosis: idiopathic PAH, PAH associated with appetite suppressants, PAH associated with connective, or Chronic Thrombo-embolism Pulmonary Hypertension;
* Patients receiving oral anticoagulants.

Exclusion Criteria:

* Impossible following;
* Bleeding at baseline;
* Life expectancy of less than 3 months;
* Pulmonary hypertension in Group 2, Group 3 (in the absence of associated pulmonary embolism) and Group 5 (in the absence of associated pulmonary embolism).

• Laurent Bertoletti, PhD, Principal investigator, CHU de Saint-Etienne

NIH grants: 2016